Abstract：
This study was designed to establish risk factors for the development of Acanthamoeba keratitis (AK) for daily disposable (DD) contact lens (CL) users compared with daily wear (DW) reusable lens users and for risks unique to DD users. This is important because, in many major economies, CL use is the principal cause of microbial keratitis, of which AK accounts for approximately 50% of cases with sight loss. Determining these AK risks informs practitioner advice and consumer behavior.
Case-control study.
Cases and controls were recruited from an Accident and Emergency Department serving South-East England. Cases were new CL users with AK recruited retrospectively from January 2011 to February 2013 and prospectively thereafter until August 2014. Controls were recruited prospectively from February 2014 to June 2015.
Analysis of a self-administered questionnaire.
Independent risk factors and population attributable risk percentage (PAR%) for AK.
A total of 83 AK cases and 122 controls were recruited; DD use was reported by 20 (24%) cases and 66 (54%) controls. In multivariable analyses adjusted for potential confounders, the odds of AK was higher for DW reusable soft lenses (odds ratio [OR], 3.84; 95% confidence interval [CI], 1.75-8.43) and rigid lenses (OR, 4.56; 95% CI, 1.03-20.19) than for DD lenses. Within the DD-using subset, AK was associated with the following modifiable risk factors: less frequent professional follow-up visits (OR, 10.12; 95% CI, 5.01-20.46); showering in lenses (OR, 3.29, 95% CI, 1.17-9.23); lens reuse (OR, 5.41; 95% CI, 1.55-18.89); and overnight wear (OR, 3.93; 95% CI, 1.15-13.46). The PAR% estimated that 30% to 62% of cases could be prevented by switching from reusable soft lens to DD lens use.
Acanthamoeba keratitis risks are increased > threefold in DW reusable lens users versus DD lens use. Acanthamoeba keratitis risks for DD lens users can be minimized by adherence to safe use guidelines (no reuse, overnight wear, or contamination by water). Safe CL use can be improved by increasing the prominence of risk avoidance information from manufacturers and regulators. Because AK accounts for half of severe keratitis in CL users, these measures can be expected to have public health benefits.
Case-control study.
Cases and controls were recruited from an Accident and Emergency Department serving South-East England. Cases were new CL users with AK recruited retrospectively from January 2011 to February 2013 and prospectively thereafter until August 2014. Controls were recruited prospectively from February 2014 to June 2015.
Analysis of a self-administered questionnaire.
Independent risk factors and population attributable risk percentage (PAR%) for AK.
A total of 83 AK cases and 122 controls were recruited; DD use was reported by 20 (24%) cases and 66 (54%) controls. In multivariable analyses adjusted for potential confounders, the odds of AK was higher for DW reusable soft lenses (odds ratio [OR], 3.84; 95% confidence interval [CI], 1.75-8.43) and rigid lenses (OR, 4.56; 95% CI, 1.03-20.19) than for DD lenses. Within the DD-using subset, AK was associated with the following modifiable risk factors: less frequent professional follow-up visits (OR, 10.12; 95% CI, 5.01-20.46); showering in lenses (OR, 3.29, 95% CI, 1.17-9.23); lens reuse (OR, 5.41; 95% CI, 1.55-18.89); and overnight wear (OR, 3.93; 95% CI, 1.15-13.46). The PAR% estimated that 30% to 62% of cases could be prevented by switching from reusable soft lens to DD lens use.
Acanthamoeba keratitis risks are increased > threefold in DW reusable lens users versus DD lens use. Acanthamoeba keratitis risks for DD lens users can be minimized by adherence to safe use guidelines (no reuse, overnight wear, or contamination by water). Safe CL use can be improved by increasing the prominence of risk avoidance information from manufacturers and regulators. Because AK accounts for half of severe keratitis in CL users, these measures can be expected to have public health benefits.
摘要：
目的：本研究旨在确定与每日佩戴（DW）可重复使用镜片使用者相比，每日一次性（DD）隐形眼镜（CL）使用者发生棘阿米巴角膜炎（AK）的危险因素以及DD使用者特有的风险。这很重要,因为,在许多主要经济体中，CL的使用是微生物性角膜炎的主要原因，其中AK约占视力丧失病例的50%。确定这些AK风险可告知从业者建议和消费者行为。
方法：病例对照研究。
方法：病例和对照来自英格兰东南部的一个事故和急诊科。病例为2011年1月至2013年2月回顾性招募的带有AK的新CL用户，此后直至2014年8月。2014年2月至2015年6月前瞻性招募了对照。
方法：分析自编问卷。
方法：AK的独立危险因素和人群归因风险百分比（PAR%）。
结果：共招募了83例AK病例和122例对照；报告了20例（24%）和66例（54%）对照使用DD。在调整了潜在混杂因素的多变量分析中，DW可重复使用的软性镜片的AK几率更高(赔率比[OR]，3.84；95%置信区间[CI]，1.75-8.43)和刚性透镜(或，4.56；95%CI，1.03-20.19）比DD镜片高。在使用DD的子集内，AK与以下可改变的危险因素相关：不太频繁的专业随访(OR，10.12；95%CI，5.01-20.46)；在镜头中淋浴(或，3.29，95%CI，1.17-9.23)；镜头重复使用(OR，5.41；95%CI，1.55-18.89)；和隔夜佩戴(OR，3.93；95%CI，1.15-13.46）。PAR％估计，通过从可重复使用的软透镜切换到DD透镜使用，可以防止30％至62％的病例。
结论：在DW可重复使用的镜片使用者中，与使用DD镜片相比，棘阿米巴角膜炎的风险增加了三倍。通过遵守安全使用指南，可以将DD镜片使用者的棘阿米巴角膜炎风险降至最低（不得重复使用，过夜穿,或被水污染)。通过增加制造商和监管机构提供的风险规避信息的重要性，可以改善CL的安全使用。因为AK占CL使用者严重角膜炎的一半，这些措施有望对公众健康带来好处。
方法：病例对照研究。
方法：病例和对照来自英格兰东南部的一个事故和急诊科。病例为2011年1月至2013年2月回顾性招募的带有AK的新CL用户，此后直至2014年8月。2014年2月至2015年6月前瞻性招募了对照。
方法：分析自编问卷。
方法：AK的独立危险因素和人群归因风险百分比（PAR%）。
结果：共招募了83例AK病例和122例对照；报告了20例（24%）和66例（54%）对照使用DD。在调整了潜在混杂因素的多变量分析中，DW可重复使用的软性镜片的AK几率更高(赔率比[OR]，3.84；95%置信区间[CI]，1.75-8.43)和刚性透镜(或，4.56；95%CI，1.03-20.19）比DD镜片高。在使用DD的子集内，AK与以下可改变的危险因素相关：不太频繁的专业随访(OR，10.12；95%CI，5.01-20.46)；在镜头中淋浴(或，3.29，95%CI，1.17-9.23)；镜头重复使用(OR，5.41；95%CI，1.55-18.89)；和隔夜佩戴(OR，3.93；95%CI，1.15-13.46）。PAR％估计，通过从可重复使用的软透镜切换到DD透镜使用，可以防止30％至62％的病例。
结论：在DW可重复使用的镜片使用者中，与使用DD镜片相比，棘阿米巴角膜炎的风险增加了三倍。通过遵守安全使用指南，可以将DD镜片使用者的棘阿米巴角膜炎风险降至最低（不得重复使用，过夜穿,或被水污染)。通过增加制造商和监管机构提供的风险规避信息的重要性，可以改善CL的安全使用。因为AK占CL使用者严重角膜炎的一半，这些措施有望对公众健康带来好处。
